TRADE Application # /Q 05 6 .�
Harnett County Central Permitting . ., o JAI
• PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793 •;
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
1 (Individual Trade Application) G M _ i UI _ ni_ _N to _ t Q
Owner (s) of Structure: . s. fta /. . kilt 1 /.,,a ■r" #; 11 - hone: gl9 - LR�I.) (Y1LQ S - (kd - t j
Owner (s) Mailing Address: '4,e SWAM; •• • •
Land Owner Name (s): � � ti ti tlo. ►►e ■ulI aa.Phone:NR - ((Ah tilln _1 u.Jci
Construction or Site Addres—.. P!.. _, i F 1,kt., ■i 1 Al 41
PIN or Parcel # from GIS: M n1y() I .3& + '
1 1 1—
Job Cost: w Description of Work to be done F \ 9C Intl; - 1 n:14n.\ 1
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Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical *: 200 Amp <200 Amp _ Service Change _ Service Reconnect _ Other_
* For Pro ess Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater _
Specific Directions to Job from Lillington:
Subdivision: Lot #:
r
I i.ST Et EC zc will provide the ELEcntc labor on this structure.
I (Contractors N e) (Trade)
I am the building owner or my NC state license number is 224'-It.,- L which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and I al laws or ' nces and regulations.
0
h. Structure owner(s) signature: •laz-- C 741/0 Date: � /0
c
d
Company Name:
p v 1:-/ c Phone: 61'11 29 \ - l yf\8
Address: ,Z7tr, Zftc v., Jvtj t_ County: A/C-x`07—
Contractor's License #: 7 t-IL( - L Email Address:
Contractor's Signature: Date: 1.2M
' *Company a s e must match information on license.
Individual Trade Application v 1 of 1 06/10
License Lookup Page 1 of 1
pR EtEri
:., State of North Carolina
Board Of Examiners
a � Of Electrical Contractors
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THIS DIRECTORY CONTAINS INFORMATION ON ALL ACTIVE ELECTRICAL CONTRACTORS LICENSED TO PRACTICE IN
NORTH CAROLINA. EXPIRED, SUSPENDED, REVOKED, AND UNLICENSED PERSONS DO NOT APPEAR.
You may search by license number (if known) or you can search using another piece of information such as the name of an individual
or a business name. If you are unsure of the actual spelling of a name, use the first few letters of the name and click "Search ".
IT IS NOT NECESSARY TO INCLUDE CLASSIFICATION CODES TO SEARCH BY LICENSE NUMBER. FOR EXAMPLE, IF THE
LICENSE NUMBER IS 24000 -U, ENTER "24000" IN THE CENTER SEARCH FIELD AND CLICK "SEARCH ".
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License Number , 22446 J -I
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License License Owner II Listed Company DBA Name City I State I Additional Qualifiers
122446 -L 'Randy James Pope II R.S.T. Electric I IlAngier I I NC INo Additional Qualifiers Listed
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